Provider Demographics
NPI:1104989649
Name:GOLDMAN, ROBERT DAVID (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:DAVID
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5637
Mailing Address - Fax:818-837-5589
Practice Address - Street 1:23929 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4466
Practice Address - Country:US
Practice Address - Phone:661-290-5330
Practice Address - Fax:661-290-5331
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19681207ND0101X
CAG44889207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1256106Medicaid
CA00G448890Medicaid
CAWG44889DMedicare PIN
CA00G448890Medicaid
WAAO4565Medicare UPIN